David Oliver: Why force GP streaming on NHS emergency departments?

Oliver, David

doi:10.1136/bmj.m992

Cited by 6 publications

(5 citation statements)

References 4 publications

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“… 31 The main cause of ED crowding is a lack of beds and congestion in the flow of sicker patients rather than absolute attendance numbers. 39 In addition, GPED may encourage patients to present to the ED with a primary care problem, with consequent increases in ED attendance. 26 40 …”

Section: Discussionmentioning

confidence: 99%

Potential impacts of general practitioners working in or alongside emergency departments in England: initial qualitative findings from a national mixed-methods evaluation

et al. 2021

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Objectives To explore the potential impacts of introducing General Practitioners into Emergency Departments (GPED) from the perspectives of service leaders, health professionals and patients. These ‘expectations of impact’ can be used to generate hypotheses that will inform future implementations and evaluations of GPED. Design Qualitative study consisting of 228 semistructured interviews. Setting 10 acute National Health Service (NHS) hospitals and the wider healthcare system in England. Interviews were undertaken face to face or via telephone. Data were analysed thematically. Participants 124 health professionals and 94 patients and carers. 10 service leaders representing a range of national organisations and government departments across England (eg, NHS England and Department of Health) were also interviewed. Results A range of GPED models are being implemented across the NHS due to different interpretations of national policy and variation in local context. This has resulted in stakeholders and organisations interpreting the aims of GPED differently and anticipating a range of potential impacts. Participants expected GPED to affect the following areas: ED performance indicators; patient outcome and experience; service access; staffing and workforce experience; and resources. Across these ‘domains of influence’, arguments for positive, negative and no effect of GPED were proposed. Conclusions Evaluating whether GPED has been successful will be challenging. However, despite uncertainty surrounding the direction of effect, there was agreement across all stakeholder groups on the areas that GPED would influence. As a result, we propose eight domains of influence that will inform our subsequent mixed-methods evaluation of GPED. Trial registration number NCT51780222.

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Section: Discussionmentioning

confidence: 99%

Potential impacts of general practitioners working in or alongside emergency departments in England: initial qualitative findings from a national mixed-methods evaluation

et al. 2021

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“… 12 The main cause of ED crowding is perceived to be congestion in the flow of sicker patients into the hospital and a lack of beds, rather than absolute attendance numbers. 53 …”

Section: Discussionmentioning

confidence: 99%

“…12 The main cause of ED crowding is perceived to be congestion in the flow of sicker patients into the hospital and a lack of beds, rather than absolute attendance numbers. 53 The GPED study shows that even when a policy is mandatory and supported by dedicated capital funding, this does not guarantee successful or uniform adoption. Our findings highlight the complexities of translating policy into practice, and the importance of considering the extent that a government-led policy can be delivered at a local level.…”

Section: Discussionmentioning

confidence: 99%

“…A recent realist review concluded that, despite GPs in ED being associated with a reduction in process time for non-urgent patients, this does not necessarily increase capacity to care for the sickest patients 12. The main cause of ED crowding is perceived to be congestion in the flow of sicker patients into the hospital and a lack of beds, rather than absolute attendance numbers 53…”

Section: Discussionmentioning

confidence: 99%

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Do general practitioners working in or alongside the emergency department improve clinical outcomes or experience? A mixed-methods study

et al. 2022

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ObjectivesTo examine the effect of general practitioners (GPs) working in or alongside the emergency department (GPED) on patient outcomes and experience, and the associated impacts of implementation on the workforce.DesignMixed-methods study: interviews with service leaders and NHS managers; in-depth case studies (n=10) and retrospective observational analysis of routinely collected national data. We used normalisation process theory to map our findings to the theory’s four main constructs of coherence, cognitive participation, collective action and reflexive monitoring.Setting and participantsData were collected from 64 EDs in England. Case site data included: non-participant observation of 142 clinical encounters; 467 semistructured interviews with policy-makers, service leaders, clinical staff, patients and carers. Retrospective observational analysis used routinely collected Hospital Episode Statistics alongside information on GPED service hours from 40 hospitals for which complete data were available.ResultsThere was disagreement at individual, stakeholder and organisational levels regarding the purpose and potential impact of GPED (coherence). Participants criticised policy development and implementation, and staff engagement was hindered by tensions between ED and GP staff (cognitive participation). Patient ‘streaming’ processes, staffing and resource constraints influenced whether GPED became embedded in routine practice. Concerns that GPED may increase ED attendance influenced staff views. Our quantitative analysis showed no detectable impact on attendance (collective action). Stakeholders disagreed whether GPED was successful, due to variations in GPED model, site-specific patient mix and governance arrangements. Following statistical adjustment for multiple testing, we found no impact on: ED reattendances within 7 days, patients discharged within 4 hours of arrival, patients leaving the ED without being seen; inpatient admissions; non-urgent ED attendances and 30-day mortality (reflexive monitoring).ConclusionsWe found a high degree of variability between hospital sites, but no overall evidence that GPED increases the efficient operation of EDs or improves clinical outcomes, patient or staff experience.Trial registration numberISCRTN5178022.

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“…It has been suggested that the “pre–primary care” health sector, where individuals have reached the stage of considering seeking formal advice on their symptoms but have not yet seen a physician, should be the target of new technological approaches to triage [ 6 ]. Building on contemporary interest in self-care, the use of digital technologies to provide detailed and accurate advice and triage provision to support individuals in “self-triage” could enable them to manage their medical problems themselves where possible, or direct them to services of a type and urgency appropriate to their symptoms or condition [ 7 , 8 ].…”

Section: Triage In Pre–primary Care: Context and Challengesmentioning

confidence: 99%

Triage Errors in Primary and Pre–Primary Care

Nguyen¹,

Meczner²,

Burslam-Dawe³

et al. 2022

J Med Internet Res

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Triage errors are a major concern in health care due to resulting harmful delays in treatments or inappropriate allocation of resources. With the increasing popularity of digital symptom checkers in pre–primary care settings, and amid claims that artificial intelligence outperforms doctors, the accuracy of triage by digital symptom checkers is ever more scrutinized. This paper examines the context and challenges of triage in primary care, pre–primary care, and emergency care, as well as reviews existing evidence on the prevalence of triage errors in all three settings. Implications for development, research, and practice are highlighted, and recommendations are made on how digital symptom checkers should be best positioned.

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David Oliver: Why force GP streaming on NHS emergency departments?

Cited by 6 publications

References 4 publications

Potential impacts of general practitioners working in or alongside emergency departments in England: initial qualitative findings from a national mixed-methods evaluation

Potential impacts of general practitioners working in or alongside emergency departments in England: initial qualitative findings from a national mixed-methods evaluation

Do general practitioners working in or alongside the emergency department improve clinical outcomes or experience? A mixed-methods study

Triage Errors in Primary and Pre–Primary Care

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